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Understanding the new GMS regulations

In which circumstances can doctors be removed from a PCT's medical list? Dr Gerard Panting explains what the new GMS regulations mean for GPs

New regulations governing the appointment and removal of GP principals from medical lists and making provision for vetting non-principals are now in force in England. Just as ill-disciplined rottweilers led to the Dangerous Dogs Act, so the Harold Shipman murders have led to the 'dangerous doctors' regulations.

Health authorities, and from 1 April 2002 PCTs, may remove a doctor's name from the medical list on grounds of unsuitability, fraud or inefficiency.

'Unsuitability', in effect, means criminal conviction. If a doctor has been found guilty of murder in the UK or, after 13 December 2001, has been sentenced to a term of imprisonment of more than 6 months, the PCT has no choice but to remove the doctor's name from the medical list.

Any doctor convicted of murder before 13 December 2001 must also be removed from the medical list. This provision appears particularly unnecessary because murder carries a mandatory life sentence and is inevitably followed by erasure from the medical register.

In all other cases of conviction before that date, the PCT may use its discretion in determining whether or not the doctor is unsuitable to remain on the list.

The regulations set out the criteria to be considered, which include:

the length of time since conviction;

the length of sentence;

whether there were other criminal offences to be considered;

the relevance of the criminal offence to professional conduct and practice;

whether any sexual offence was involved.

The Rehabilitation of Offenders Act, which enables some criminal convictions to become 'spent' after a rehabilitation period, does not apply to registered medical practitioners. Consequently, a doctor can never regard a conviction as being spent.

Fraud cases are not confined to those where there has been a criminal conviction. Again, criteria are set out for each health authority or PCT to consider whether or not the doctor's name should be removed from the medical list.

Efficiency cases arise when a doctor's professional performance is deemed to be prejudicial to the efficiency of the provision of general medical services. Criteria to be considered include whether the doctor has failed to comply with a request by the PCT to undertake an assessment by the National Clinical Assessment Authority (NCAA).

The regulations also amend the doctors' terms of service to add a new paragraph, 50(a), which states: 'A doctor shall co-operate with an assessment by the NCAA when requested to do so by the health authority.'

In preparation for the new regime, health authorities distributed questionnaires during the first quarter of 2002 requiring doctors to give information about any previous criminal convictions and investigations of professional conduct and competence. The information requested is listed in Box 1 (below).

In future, a doctor must give details to the PCT within 7 days of conviction, binding over, police caution or any adverse findings equivalent to those set out in Box 1. Doctors must also consent to the PCT making enquiries of any previous employer or regulatory body.

Box 1: Information principals must supply to health authorities

By 31 March 2002, doctors must supply in writing to the health authority information relating to whether he or she:

has any criminal convictions in the United Kingdom

has been bound over following a criminal conviction in the United Kingdom1

has accepted a police caution in the United Kingdom

has been convicted elsewhere of an offence or what would constitute a criminal offence if committed in England and Wales or is subject to a penalty which would be the equivalent of being bound over or cautioned

is currently the subject of any proceedings which might lead to a conviction not yet notified to the health authority

has been subject to an investigation into professional conduct by any licensing, regulatory or other body anywhere in the world where the outcome was adverse2

is currently subject to any investigation into his or her professional conduct by any licensing, regulatory or other body anywhere in the world

is, to his or her knowledge, or has been where the outcome was adverse, the subject of any investigation by the National Health Service Counter Fraud Service in relation to any fraud case

is the subject of any investigation by another health authority or equivalent body which might lead to removal from medical list or equivalent lists

is, or has been where the outcome was adverse, subject to an investigation into his or her professional conduct in respect of any current or previous employment3

has been removed, contingently removed, refused admission to, or conditionally included in any list or equivalent list kept by another health authority or equivalent body, or is currently suspended from such a list

Supplementary list regulations

Supplementary list regulations require PCTs to prepare and publish a supplementary list of all doctors approved for the purpose of assisting in the provision of general medical services.

The list should include the doctor's full name, professional registration number, date of birth (subject to his or her consent) and the date the doctor's name was included on the list. The list must be available for public inspection.

Doctors applying for inclusion on the supplementary list are required to provide specified personal details including professional experience and any previous adverse findings.

The criteria for accepting or removing a doctor's name onto or from the supplementary list mirror the criteria that apply to GP principals.

Removal from a medical list

When a PCT is considering removing a doctor's name from the medical list it must give the doctor:

notice in writing of any allegation against him or her;

notice of what action a PCT is considering and on what grounds;

the opportunity to make written representations to the PCT within 28 days;

the opportunity to put his or her case at an oral hearing before the PCT within the same 28-day period.

The doctor must also be informed of any decisions and the reasons behind them and rights of appeal.

PCTs are required under the regulations to notify a variety of bodies, including the GMC and the local medical committee of any decision to remove a doctor's name from the medical list.

Suspension

If suspension from the medical or supplementary list is contemplated, the PCT must give the doctor:

notice in writing of any allegation against him or her;

notice of what action the PCT is contemplating and on what grounds;

the opportunity to put his or her case at an oral hearing before the PCT on a specified day provided that at least 24 hours' notice of the hearing is given;

notice of his or her right to review.

During the period of suspension, the PCT is required to make payments to the suspended doctor in accordance with the Secretary of State's determination.

National disqualification

The PCT, following its own decision to disqualify, may - and almost certainly will -refer the matter to the Family Health Services Appeal Authority. The FHSAA, following its own review, may impose a national disqualification from inclusion of the doctor's name on any PCT medical list in addition to the local disqualification.

Refusal to include a doctor on the medical list

PCTs may refuse to approve or nominate a doctor for inclusion on the medical list on the grounds of unsuitability, applying the same criteria as set out above.

PCTs may also defer a decision to approve or nominate a doctor for inclusion on the medical list where there are legal proceedings or an investigation by a licensing or regulatory body or other investigation anywhere in the world that would be criminal proceedings if brought in the United Kingdom and that would, if successful, be likely to lead to removal of the doctor's name from the PCT list.

Appeal to the FHSAA

A doctor may appeal to the FHSAA against the PCT's decision. That appeal is by way of redetermination -in other words, there is a new hearing.

Conditional inclusion

A PCT may accept a doctor onto the medical list subject to certain conditions on that inclusion. The imposition of conditions is open to appeal to the FHSAA.

Engaging deputies and assistants

As from 1 April 2002, GP principals may not engage a doctor as a deputy or assistant unless that doctor's name appears on the supplementary list or medical list.

GPs are also required to obtain two clinical references relating to two recent posts. If this is not possible, he or she must obtain a full explanation for the lack of references, obtain alternative referees, and must check and be satisfied by those references.

Where a doctor is urgently needed, a 14-day leeway period is allowed to complete taking up references.

Conclusion

The new regulations place the onus upon the doctor to inform the PCT not just of adverse findings but also of investigations that might lead to a critical outcome, even though the GMC already notifies bodies with whom a doctor works when an investigation proceeds beyond the screening stage.

The wording is taken directly from the regulations but binding over is a civil remedy in place of criminal conviction and does not follow a criminal conviction.

An adverse finding means a finding of serious professional misconduct, seriously deficient performance or a health committee decision that the doctor's registration should be subject to conditions or suspended.

Professional conduct is construed as including professional performance.